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2.
BMC Public Health ; 22(1): 475, 2022 03 10.
Article in English | MEDLINE | ID: covidwho-1736400

ABSTRACT

BACKGROUND: Behaviour is key to suppressing the COVID-19 pandemic. Maintaining behaviour change can be difficult. We investigated engagement with hand cleaning, reducing the number of outings, and wearing a face covering over the course of the pandemic. METHODS: We used a series of 64 cross-sectional surveys between 10 February 2020 and 20 January 2022 (n ≈ 2000 per wave). Surveys investigated uptake of hand cleaning behaviours, out of home activity (England only, n ≈ 1700 per wave) and wearing a face covering (England only, restricted to those who reported going out shopping in the last week, n ≈ 1400 per wave). RESULTS: Reported hand cleaning has been high throughout the pandemic period (85 to 90% of participants consistently reporting washing their hands thoroughly and regularly with soap and water frequently or very frequently). Out of home activity has mirrored the easing and re-introduction of restrictive measures. Total number of outings were higher in the second national lockdown than in the first and third lockdowns. Wearing a face covering increased steadily between April to August 2020, plateauing until the end of measurement in May 2021, with approximately 80% of those who had been out shopping in the previous week reporting wearing a face covering frequently or very frequently. CONCLUSIONS: Engagement with protective behaviours increased at the start of the pandemic and has remained high since. The greatest variations in behaviour reflected changes to Government rules. Despite the duration of restrictions, people have continued to adopt personal protective behaviours that were intended to prevent the spread of COVID-19.


Subject(s)
COVID-19 , Influenza, Human , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control , Cross-Sectional Studies , Humans , Influenza, Human/epidemiology , Pandemics/prevention & control , SARS-CoV-2 , United Kingdom/epidemiology
4.
BMJ Open ; 12(2): e058060, 2022 02 10.
Article in English | MEDLINE | ID: covidwho-1685597

ABSTRACT

OBJECTIVES: To investigate uptake of lateral flow testing, reporting of test results and psychological, contextual and socio-demographic factors associated with testing. DESIGN: A series of four fortnightly online cross-sectional surveys. SETTING: Data collected from 19 April 2021 to 2 June 2021. PARTICIPANTS: People living in England and Scotland, aged 18 years or over, excluding those who reported their most recent test was a polymerase chain reaction (PCR) test (n=6646, n≈1600 per survey). MAIN OUTCOME MEASURES: Having completed at least one lateral flow test (LFT) in the last 7 days. RESULTS: We used binary logistic regressions to investigate factors associated with having taken at least one LFT. Increased uptake of testing was associated with being vaccinated (adjusted ORs (aORs)=1.52-2.45, 95% CI 1.25 to 3.07, analysed separately by vaccine dose), employed (aOR=1.94, 95% CI 1.63 to 2.32), having been out to work in the last week (aOR=2.30, 95% CI 1.94 to 2.73) and working in a sector that adopted LFT early (aOR=2.54, 95% CI 2.14 to 3.02) . Uptake was higher in people who reported cardinal COVID-19 symptoms in the last week (aOR=1.89, 95% CI 1.34 to 2.66). People who had heard more about LFTs (aOR=2.28, 95% CI 2.06 to 2.51) and knew they were eligible to receive regular LFTs (aOR=2.98, 95% CI 2.35 to 3.78) were also more likely to have tested. Factors associated with not taking a test included agreeing that you do not need to test for COVID-19 unless you have come into contact with a case (aOR=0.51, 95% CI 0.47 to 0.55). CONCLUSIONS: Uptake of lateral flow testing is low. Encouraging testing through workplaces and places of study is likely to increase uptake, although care should be taken not to pressurise employees and students. Increasing knowledge that everyone is eligible for regular asymptomatic testing and addressing common misconceptions may drive uptake.


Subject(s)
COVID-19 , Adolescent , COVID-19 Testing , Cross-Sectional Studies , Humans , SARS-CoV-2 , United Kingdom
6.
Prev Med Rep ; 25: 101686, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1655027

ABSTRACT

We aimed to describe worry and uptake of behaviours that prevent the spread of infection (respiratory and hand hygiene, distancing) in the UK at the start of the COVID-19 outbreak (January and February 2020) and to investigate factors associated with worry and adopting protective behaviours. Three cross-sectional online surveys of UK adults (28 to 30 January, n = 2016; 3 to 6 February, n = 2002; 10 to 13 February 2020, n = 2006) were conducted. We used logistic regressions to investigate associations between outcome measures (worry, respiratory and hand hygiene behaviour, distancing behaviour) and explanatory variables. 19.8% of participants (95% CI 18.8% to 20.8%) were very or extremely worried about COVID-19. People from minoritized ethnic groups were particularly likely to feel worried. 39.9% of participants (95% CI 37.7% to 42.0%) had completed one or more hand or respiratory hygiene behaviour more than usual in the last seven days. Uptake was associated with greater worry, perceived effectiveness of individual behaviours, self-efficacy for engaging in them, and having heard more information about COVID-19. 13.7% (95% CI 12.2% to 15.2%) had reduced the number of people they had met. This was associated with greater worry, perceived effectiveness, and self-efficacy. At the start of novel infectious disease outbreaks, communications should emphasise perceived effectiveness of behaviours and the ease with which they can be carried out.

7.
Health Policy ; 126(3): 234-244, 2022 03.
Article in English | MEDLINE | ID: covidwho-1620689

ABSTRACT

The COVID-19 pandemic has shone a light on the complex relationship between science and policy. Policymakers have had to make decisions at speed in conditions of uncertainty, implementing policies that have had profound consequences for people's lives. Yet this process has sometimes been characterised by fragmentation, opacity and a disconnect between evidence and policy. In the United Kingdom, concerns about the secrecy that initially surrounded this process led to the creation of Independent SAGE, an unofficial group of scientists from different disciplines that came together to ask policy-relevant questions, review the evolving evidence, and make evidence-based recommendations. The group took a public health approach with a population perspective, worked in a holistic transdisciplinary way, and were committed to public engagement. In this paper, we review the lessons learned during its first year. These include the importance of learning from local expertise, the value of learning from other countries, the role of civil society as a critical friend to government, finding appropriate relationships between science and policy, and recognising the necessity of viewing issues through an equity lens.


Subject(s)
COVID-19 , Pandemics , Communication , Emergencies , Humans , SARS-CoV-2 , United Kingdom
10.
Br J Health Psychol ; 2021 Nov 30.
Article in English | MEDLINE | ID: covidwho-1541704

ABSTRACT

OBJECTIVES: (1) To investigate factors associated with intention to self-isolate, request a test, and share details of close contacts when required. (2) To determine whether associations were stronger during periods when less stringent national COVID-19 restrictions were in place. DESIGN: Series of cross-sectional nationally representative surveys. We selected survey waves where different national restrictions were in place in England (first lockdown, summer release, second lockdown, third lockdown). METHODS: We investigated whether psychological factors and increased out-of-home activity in the last week were associated with intention to self-isolate and request a test if you were to develop COVID-19 symptoms, and intention to share details of contacts if you were to test positive. We also investigated whether the strength of associations differed by timepoint in the pandemic. RESULTS: Intention to self-isolate, request a test and share details of contacts were associated with greater perceived risk of COVID-19 to people in the United Kingdom, knowing that COVID-19 transmission can be asymptomatic, and agreeing that personal behaviour has an impact on COVID-19 transmission. There were few differences in strength of associations by timepoint suggesting these effects are broadly stable over time. CONCLUSIONS: Psychological factors were associated with intention to adhere to key components of the contact tracing system; there was no evidence for an association with increased out-of-home activity. Messages that increase knowledge that COVID-19 can be transmitted even if someone does not have symptoms and that an individual's actions can contribute to the spread of the virus may promote engagement with the test, trace, and isolate system.

11.
BMJ ; 375: n2729, 2021 11 17.
Article in English | MEDLINE | ID: covidwho-1522940
12.
J R Soc Med ; 114(11): 513-524, 2021 11.
Article in English | MEDLINE | ID: covidwho-1488342

ABSTRACT

OBJECTIVE: To offer a quantitative risk-benefit analysis of two doses of SARS-CoV-2 vaccination among adolescents in England. SETTING: England. DESIGN: Following the risk-benefit analysis methodology carried out by the US Centers for Disease Control, we calculated historical rates of hospital admission, Intensive Care Unit admission and death for ascertained SARS-CoV-2 cases in children aged 12-17 in England. We then used these rates alongside a range of estimates for incidence of long COVID, vaccine efficacy and vaccine-induced myocarditis, to estimate hospital and Intensive Care Unit admissions, deaths and cases of long COVID over a period of 16 weeks under assumptions of high and low case incidence. PARTICIPANTS: All 12-17 year olds with a record of confirmed SARS-CoV-2 infection in England between 1 July 2020 and 31 March 2021 using national linked electronic health records, accessed through the British Heart Foundation Data Science Centre. MAIN OUTCOME MEASURES: Hospitalisations, Intensive Care Unit admissions, deaths and cases of long COVID averted by vaccinating all 12-17 year olds in England over a 16-week period under different estimates of future case incidence. RESULTS: At high future case incidence of 1000/100,000 population/week over 16 weeks, vaccination could avert 4430 hospital admissions and 36 deaths over 16 weeks. At the low incidence of 50/100,000/week, vaccination could avert 70 hospital admissions and two deaths over 16 weeks. The benefit of vaccination in terms of hospitalisations in adolescents outweighs risks unless case rates are sustainably very low (below 30/100,000 teenagers/week). Benefit of vaccination exists at any case rate for the outcomes of death and long COVID, since neither have been associated with vaccination to date. CONCLUSIONS: Given the current (as at 15 September 2021) high case rates (680/100,000 population/week in 10-19 year olds) in England, our findings support vaccination of adolescents against SARS-CoV2.


Subject(s)
COVID-19 Vaccines , COVID-19/prevention & control , Hospitalization , Intensive Care Units , Public Health , Severity of Illness Index , Vaccination , Adolescent , Adolescent Health , Age Factors , COVID-19/complications , COVID-19/mortality , COVID-19/therapy , COVID-19 Vaccines/adverse effects , Child , Child Health , England , Female , Humans , Incidence , Male , Myocarditis/etiology , Risk , SARS-CoV-2 , Treatment Outcome , Vaccination/adverse effects
13.
Vaccine ; 39(48): 7108-7116, 2021 11 26.
Article in English | MEDLINE | ID: covidwho-1458555

ABSTRACT

BACKGROUND: Vaccination intention is key to the success of any vaccination programme, alongside vaccine availability and access. Public intention to take a COVID-19 vaccine is high in England and Wales compared to other countries, but vaccination rate disparities between ethnic, social and age groups has led to concern. METHODS: Online survey of prospective household community cohort study participants across England and Wales (Virus Watch). Vaccination intention was measured by individual participant responses to 'Would you accept a COVID-19 vaccine if offered?', collected in December 2020 and February 2021. Responses to a 13-item questionnaire collected in January 2021 were analysed using factor analysis to investigate psychological influences on vaccination intention. RESULTS: Survey response rate was 56% (20,785/36,998) in December 2020 and 53% (20,590/38,727) in February 2021, with 14,880 adults reporting across both time points. In December 2020, 1,469 (10%) participants responded 'No' or 'Unsure'. Of these people, 1,266 (86%) changed their mind and responded 'Yes' or 'Already had a COVID-19 vaccine' by February 2021. Vaccination intention increased across all ethnic groups and levels of social deprivation. Age was most strongly associated with vaccination intention, with 16-24-year-olds more likely to respond "Unsure" or "No" versus "Yes" than 65-74-year-olds in December 2020 (OR: 4.63, 95 %CI: 3.42, 6.27 & OR 7.17 95 %CI: 4.26, 12.07 respectively) and February 2021 (OR: 27.92 95 %CI: 13.79, 56.51 & OR 17.16 95 %CI: 4.12, 71.55). The association between ethnicity and vaccination intention weakened, but did not disappear, over time. Both vaccine- and illness-related psychological factors were shown to influence vaccination intention. CONCLUSIONS: Four in five adults (86%) who were reluctant or intending to refuse a COVID-19 vaccine in December 2020 had changed their mind in February 2021 and planned to accept, or had already accepted, a vaccine.


Subject(s)
COVID-19 Vaccines , COVID-19 , Adult , Cohort Studies , England , Humans , Intention , Prospective Studies , SARS-CoV-2 , Vaccination , Wales/epidemiology
14.
Br J Health Psychol ; 27(2): 588-604, 2022 May.
Article in English | MEDLINE | ID: covidwho-1450537

ABSTRACT

OBJECTIVES: To identify the prevalence of a stigmatizing attitude towards people of Chinese origin at the start of the COVID-19 outbreak in the UK population and investigate factors associated with holding the stigmatizing attitude. DESIGN: Online cross-sectional survey conducted 10-13 February 2020 (n = 2006, people aged 16 years or over and living in the UK). METHODS: We asked participants to what extent they agreed it was best to avoid areas heavily populated by Chinese people because of the COVID-19 outbreak. Survey materials also asked about: worry, perceived risk, knowledge, information receipt, perception of government response to COVID-19, and personal characteristics. We ran binary logistic regressions to investigate associations between holding a stigmatizing attitude, personal characteristics, and psychological and contextual factors. RESULTS: 26.1% people (95% CI 24.2-28.0%, n = 524/2006) agreed it was best to avoid areas heavily populated by Chinese people. Holding a stigmatizing attitude was associated with greater worry about COVID-19, greater perceived risk of COVID-19, and poorer knowledge about COVID-19. CONCLUSIONS: At the start of the COVID-19 pandemic, a large percentage of the UK public endorsed avoiding areas in the UK heavily populated by people of Chinese origin. This attitude was associated with greater worry about, and perceived risk of, the COVID-19 outbreak as well as poorer knowledge about COVID-19. At the start of future novel infectious disease outbreaks, proactive communications from official sources should provide context and facts to reduce uncertainty and challenge stigmatizing attitudes, to minimize harms to affected communities.


Subject(s)
COVID-19 , Attitude , Cross-Sectional Studies , Disease Outbreaks , Humans , Pandemics , SARS-CoV-2 , Surveys and Questionnaires
15.
Br J Health Psychol ; 26(4): 1238-1257, 2021 11.
Article in English | MEDLINE | ID: covidwho-1379562

ABSTRACT

OBJECTIVES: The Scientific Pandemic Insights group on Behaviours (SPI-B) as part of England's Scientific Advisory Group on Emergencies (SAGE), were commissioned by the UK Cabinet Office to identify strategies to embed infection control behaviours to minimize Covid-19 transmission in the long term. METHODS: With minimal direct evidence available, three sources of information were used to develop a set of proposals: (1) a scoping review of literature on sustaining behaviour change, (2) a review of key principles used in risk and safety management, and (3) prior reports and reviews on behaviour change from SPI-B. The information was collated and refined through discussion with SPI-B and SAGE colleagues to finalize the proposals. RESULTS: Embedding infection control behaviours in the long-term will require changes to the financial, social, and physical infrastructure so that people in all sections of society have the capability, opportunity, and motivation needed to underpin those behaviours. This will involve building Covid-safe educational programmes, regulating to ensure minimum standards of safety in public spaces and workspaces, using communications and social marketing to develop a Covid-safe culture and identity, and providing resources so that all sections of society can build Covid-safe behaviours into their daily lives. CONCLUSIONS: Embedding 'Covid-safe' behaviours into people's everyday routines will require a co-ordinated programme to shape the financial, physical, and social infrastructure in the United Kingdom. Education, regulation, communications, and social marketing, and provision of resources will be required to ensure that all sections of society have the capability, opportunity, and motivation to enact the behaviours long term.


Subject(s)
COVID-19 , Humans , SARS-CoV-2 , United Kingdom
17.
BMJ Open ; 11(7): e047832, 2021 06 29.
Article in English | MEDLINE | ID: covidwho-1288392

ABSTRACT

OBJECTIVE: To systematically learn lessons from the experiences of countries implementing find, test, trace, isolate, support (FTTIS) in the first wave of the COVID-19 pandemic. DESIGN, DATA SOURCES AND ELIGIBILITY CRITERIA: We searched MEDLINE (PubMed), Cochrane Library, SCOPUS and JSTOR, initially between 31 May 2019 and 21 January 2021. Research articles and reviews on the use of contact tracing, testing, self-isolation and quarantine for COVID-19 management were included in the review. DATA EXTRACTION AND SYNTHESIS: We extracted information including study objective, design, methods, main findings and implications. These were tabulated and a narrative synthesis was undertaken given the diverse research designs, methods and implications. RESULTS: We identified and included 118 eligible studies. We identified the core elements of an effective find, test, trace, isolate, support (FTTIS) system needed to interrupt the spread of a novel infectious disease, where treatment or vaccination was not yet available, as pertained in the initial stages of the COVID-19 pandemic. We report methods used to shorten case finding time, improve accuracy and efficiency of tests, coordinate stakeholders and actors involved in an FTTIS system, support individuals isolating and make appropriate use of digital tools. CONCLUSIONS: We identified in our systematic review the key components of an FTTIS system. These include border controls, restricted entry, inbound traveller quarantine and comprehensive case finding; repeated testing to minimise false diagnoses and pooled testing in resource-limited circumstances; extended quarantine period and the use of digital tools for contact tracing and self-isolation. Support for mental or physical health and livelihoods is needed for individuals undergoing self-isolation/quarantine. An integrated system with rolling-wave planning can best use effective FTTIS tools to respond to the fast-changing COVID-19 pandemic. Results of the review may inform countries considering implementing these measures.


Subject(s)
COVID-19 , Pandemics , Humans , Policy , Quarantine , SARS-CoV-2
18.
BMJ Open ; 11(6): e048042, 2021 06 23.
Article in English | MEDLINE | ID: covidwho-1285085

ABSTRACT

INTRODUCTION: The coronavirus (COVID-19) pandemic has caused significant global mortality and impacted lives around the world. Virus Watch aims to provide evidence on which public health approaches are most likely to be effective in reducing transmission and impact of the virus, and will investigate community incidence, symptom profiles and transmission of COVID-19 in relation to population movement and behaviours. METHODS AND ANALYSIS: Virus Watch is a household community cohort study of acute respiratory infections in England and Wales and will run from June 2020 to August 2021. The study aims to recruit 50 000 people, including 12 500 from minority ethnic backgrounds, for an online survey cohort and monthly antibody testing using home fingerprick test kits. Nested within this larger study will be a subcohort of 10 000 individuals, including 3000 people from minority ethnic backgrounds. This cohort of 10 000 people will have full blood serology taken between October 2020 and January 2021 and repeat serology between May 2021 and August 2021. Participants will also post self-administered nasal swabs for PCR assays of SARS-CoV-2 and will follow one of three different PCR testing schedules based on symptoms. ETHICS AND DISSEMINATION: This study has been approved by the Hampstead National Health Service (NHS) Health Research Authority Ethics Committee (ethics approval number 20/HRA/2320). We are monitoring participant queries and using these to refine methodology where necessary, and are providing summaries and policy briefings of our preliminary findings to inform public health action by working through our partnerships with our study advisory group, Public Health England, NHS and government scientific advisory panels.


Subject(s)
COVID-19 , Guideline Adherence/statistics & numerical data , Patient Acceptance of Health Care/statistics & numerical data , Public Health , COVID-19/epidemiology , England/epidemiology , Humans , Prospective Studies , Risk Factors , State Medicine , Wales/epidemiology
19.
Br J Health Psychol ; 27(1): 215-264, 2022 02.
Article in English | MEDLINE | ID: covidwho-1281980

ABSTRACT

PURPOSE: Increasing personal protective behaviours is critical for stopping the spread of respiratory viruses, including SARS-CoV-2: We need evidence to inform how to achieve this. We aimed to synthesize evidence on interventions to increase six personal protective behaviours (e.g., hand hygiene, face mask use, maintaining physical distancing) to limit the spread of respiratory viruses. METHODS: We used best practice for rapid evidence reviews. We searched Ovid MEDLINE and Scopus. Studies conducted in adults or children with active or passive comparators were included. We extracted data on study design, intervention content, mode of delivery, population, setting, mechanism(s) of action, acceptability, practicability, effectiveness, affordability, spill-over effects, and equity impact. Study quality was assessed with Cochrane's risk-of-bias tool. A narrative synthesis and random-effects meta-analyses were conducted. RESULTS: We identified 39 studies conducted across 15 countries. Interventions targeted hand hygiene (n = 30) and/or face mask use (n = 12) and used two- or three-arm study designs with passive comparators. Interventions were typically delivered face-to-face and included a median of three behaviour change techniques. The quality of included studies was low. Interventions to increase hand hygiene (k = 6) had a medium, positive effect (d = .62, 95% CI = 0.43-0.80, p < .001, I2 = 81.2%). Interventions targeting face mask use (k = 4) had mixed results, with an imprecise pooled estimate (OR = 4.14, 95% CI = 1.24-13.79, p < .001, I2 = 89.67%). Between-study heterogeneity was high. CONCLUSIONS: We found low-quality evidence for positive effects of interventions targeting hand hygiene, with unclear results for interventions targeting face mask use. There was a lack of evidence for most behaviours of interest within this review.


Subject(s)
COVID-19 , Adult , Bias , Child , Humans , Masks , SARS-CoV-2
20.
Environ Health Insights ; 15: 11786302211015588, 2021.
Article in English | MEDLINE | ID: covidwho-1238689

ABSTRACT

Ventilating indoor spaces helps prevent COVID-19 transmission. We investigated self-reported rates of opening windows to improve ventilation in the home, perceived effectiveness of opening windows, and confidence that if you wanted to, you could open windows. One in 6 people reported rarely, if ever, opening windows in their home in the last week. Three in 4 people knew that opening windows to improve ventilation was an effective way to prevent the spread of COVID-19 and 5 in 6 were confident that they could open windows in their home. Official messaging should continue to seek to improve knowledge about the effectiveness of ventilation for reducing COVID-19 transmission, and increase the frequency of window opening.

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